Provider Demographics
NPI:1366214488
Name:LARSEN, JOSHUA (LICSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PINE ST N
Mailing Address - Street 2:
Mailing Address - City:MORA
Mailing Address - State:MN
Mailing Address - Zip Code:55051-1320
Mailing Address - Country:US
Mailing Address - Phone:320-679-6964
Mailing Address - Fax:
Practice Address - Street 1:23 PINE ST N
Practice Address - Street 2:
Practice Address - City:MORA
Practice Address - State:MN
Practice Address - Zip Code:55051-1320
Practice Address - Country:US
Practice Address - Phone:320-679-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN298021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical